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Are medical students at high risk for depression and suicidal ideation?
In this meta-analysis, the overall prevalence of depression or depressive symptoms among medical students was 27.2%, and the overall prevalence of suicidal ideation was 11.1%. Among medical students who screened positive for depression, 15.7% sought psychiatric treatment.
The overall prevalence of depressive symptoms among medical students in this study was higher than that reported in the general population, which underscores the need for effective preventive efforts and increased access to care for medical students.
Medical students are at high risk for depression and suicidal ideation. However, the prevalence estimates of these disorders vary between studies.
To estimate the prevalence of depression, depressive symptoms, and suicidal ideation in medical students.
Data Sources and Study Selection
Systematic search of EMBASE, ERIC, MEDLINE, psycARTICLES, and psycINFO without language restriction for studies on the prevalence of depression, depressive symptoms, or suicidal ideation in medical students published before September 17, 2016. Studies that were published in the peer-reviewed literature and used validated assessment methods were included.
Data Extraction and Synthesis
Information on study characteristics; prevalence of depression or depressive symptoms and suicidal ideation; and whether students who screened positive for depression sought treatment was extracted independently by 3 investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression.
Main Outcomes and Measures
Point or period prevalence of depression, depressive symptoms, or suicidal ideation as assessed by validated questionnaire or structured interview.
Depression or depressive symptom prevalence data were extracted from 167 cross-sectional studies (n = 116 628) and 16 longitudinal studies (n = 5728) from 43 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of depression or depressive symptoms was 27.2% (37 933/122 356 individuals; 95% CI, 24.7% to 29.9%, I2 = 98.9%). Summary prevalence estimates ranged across assessment modalities from 9.3% to 55.9%. Depressive symptom prevalence remained relatively constant over the period studied (baseline survey year range of 1982-2015; slope, 0.2% increase per year [95% CI, −0.2% to 0.7%]). In the 9 longitudinal studies that assessed depressive symptoms before and during medical school (n = 2432), the median absolute increase in symptoms was 13.5% (range, 0.6% to 35.3%). Prevalence estimates did not significantly differ between studies of only preclinical students and studies of only clinical students (23.7% [95% CI, 19.5% to 28.5%] vs 22.4% [95% CI, 17.6% to 28.2%]; P = .72). The percentage of medical students screening positive for depression who sought psychiatric treatment was 15.7% (110/954 individuals; 95% CI, 10.2% to 23.4%, I2 = 70.1%). Suicidal ideation prevalence data were extracted from 24 cross-sectional studies (n = 21 002) from 15 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of suicidal ideation was 11.1% (2043/21 002 individuals; 95% CI, 9.0% to 13.7%, I2 = 95.8%). Summary prevalence estimates ranged across assessment modalities from 7.4% to 24.2%.
Conclusions and Relevance
In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among medical students was 27.2% and that of suicidal ideation was 11.1%. Further research is needed to identify strategies for preventing and treating these disorders in this population.
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Corresponding Author: Douglas A. Mata, MD, MPH, Division of MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women’s Hospital, Brigham Education Institute, Harvard Medical School, 75 Francis St, Boston, MA 02115 (firstname.lastname@example.org).
Author Contributions: Dr Mata had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the analysis. Ms Rotenstein, Messrs Ramos and Segal, and Dr Torre are equal contributors.
Concept and design: Mata.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Mata.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Mata.
Obtained funding: Guille, Sen, Mata.
Administrative, technical, or material support: Guille, Sen, Mata.
Study supervision: Guille, Sen, Mata.
Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
Funding/Support: Funding was provided by the National Institutes of Health (MSTP TG 2T32GM07205 awarded to Mr Ramos and grant R01MH101459 awarded to Dr Sen) and the US Department of State (Fulbright Scholarship awarded to Dr Mata).
Role of the Funder/Sponsor: The National Institutes of Health and the US Department of State had no role in the design and conduct of the study; the collection, management, analysis, or interpretation of the data; the preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.
Disclaimer: The opinions, results, and conclusions reported in this article are those of the authors and are independent from the National Institutes of Health and the US Department of State.
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